Southern Pulmonary Care Services Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

04138102.5 Issued in MS

Legal business name

SOUTHERN PULMONARY CARE SERVICES INC

Practice address

316A Coffee St
Pontotoc, MS 38863-2606

Phone

(662) 489-3116

Fax

(662) 489-3388

NPI assigned

Jul 1, 2005

Last updated

Aug 2, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carl Wayne Mahon, CRT

Title

Owner

Phone

(662) 489-3116

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312243200000",
    "number": "1740287028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388630041",
            "telephone_number": "662-489-3116",
            "fax_number": "662-489-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316A COFFEE ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388632606",
            "telephone_number": "662-489-3116",
            "fax_number": "662-489-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PULMONARY CARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2011-08-02",
        "status": "A",
        "authorized_official_last_name": "MAHON",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-489-3116",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRT"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "MS",
            "license": "02615/11.1",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "04138102.5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00040190",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Pontotoc, MS
• Providers in Pontotoc, MS by specialty
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.